Topic
Referral
About: Referral is a research topic. Over the lifetime, 27614 publications have been published within this topic receiving 479918 citations.
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TL;DR: Scope of the program includes pretransitional assessments and interventions, including education, counseling, and referral around career, postsecondary education, sexuality, and other transitional issues.
Abstract: Older adolescents are in the midst of many life changes related to physical and emotional development, education and career choices, family and peer relationships The presence of a chronic disease adds an additional burden At this stage of development, transfer of care to an adult facility becomes a major challenge for the adolescent, parents, and pediatric and adult care providers This article describes an interdisciplinary transition program from pediatric to adult health care for older adolescents with rheumatic diseases Care is transferred to an internist-rheumatologist who collaborates closely with the pediatric team Scope of the program includes pretransitional assessments and interventions, including education, counseling, and referral around career, postsecondary education, sexuality, and other transitional issues Benefits of and barriers to a structured transition program are discussed
94 citations
TL;DR: Recruitment rates depended on the method and rate of GP referrals, the proportion of referrals meeting the entry criteria and the proportionof patients available to attend the exercise classes.
Abstract: BACKGROUND There are many factors affecting recruitment to trials in primary care, and trials are often jeopardized due to the inability to enter sufficient patient numbers. It is generally agreed that the interest in and commitment of GPs to the project are important, and their forgetfulness and time pressures are major factors which mitigate against maximal recruitment. OBJECTIVES The aim of this study is to focus on maximizing recruitment of patients to a randomized controlled trial of exercise classes for back pain patients. METHODS Two distinct methods of recruitment were used. One practice provided a computerized list of names and asked patients' permission, by letter, to be contacted by the researchers. The other 18 practices manually recorded referrals after the consultation by the GP. RESULTS Referral rates were slower than expected. Many patients either did not fit the inclusion criteria or excluded themselves due to domestic commitments or work. During 24 months, 1588 patients were referred. A total of 187 patients (12%) met the criteria and could be included in the study. The practice which referred patients through a computerized listing contributed 44% of the patients successfully included in the study. CONCLUSIONS Recruitment rates depended on the method and rate of GP referrals, the proportion of referrals meeting the entry criteria and the proportion of patients available to attend the exercise classes.
94 citations
TL;DR: Intolerance of the volume of their bleeding is not a key feature among women attending clinics for bleeding problems, which raises concerns about conceptualisation and assessment of menstrual complaint and the appropriateness of healthcare provision.
Abstract: Objectives: To describe the menstrual experience of women referred for menstrual problems, in particular menorrhagia (excessive menstrual loss), and to assess associations with reasons for referral given by their general practitioners, the women9s understanding of the reasons for their attendance at the hospital clinics, and clinic outcome. Design: Questionnaire survey, with partial review of case notes after 8 months. Setting: Three hospital gynaecology clinics in Glasgow and Edinburgh. Participants: 952 women completed the questionnaire, and the first 665 were reviewed. Outcome measures: Reason for referral, women9s reported menstrual problems and reason for clinic attendance, diagnosis, and treatment. Results: Only 38% (95% confidence interval 34% to 41%) of women reported excessive menstrual loss as a severe problem. However 60% (57-63%) gave it as reason for attending a clinic, and 76% (73-79%) of general practitioners gave it as reason for referral. Reason for referral was significantly biased towards bleeding (McNemar odds ratio 4.01, 3.0 to 5.3, P Conclusions: Intolerance of the volume of their bleeding is not a key feature among women attending clinics for bleeding problems. Broad menstrual complaint tends to be reframed as excessive bleeding at referral and during management. This may result in women receiving inappropriate care. Conceptualisation and assessment of menorrhagia requires reconsideration. What is already known on this topic Excessive menstrual loss (menorrhagia) is one of the commonest reasons for secondary referral of women, but there is no formalised clinical assessment in routine use Management typically involves potent drugs or invasive surgery, with 60% of women having hysterectomy within 5 years Many women referred for menorrhagia have menstrual blood loss that is not excessive What this study adds Discordance exists between symptoms and both referral and diagnostic pathways, arising from a disproportionate focus on menstrual bleeding Among women referred for menorrhagia, volume of bleeding is not a key symptom This raises concerns about conceptualisation and assessment of menstrual complaint and the appropriateness of healthcare provision
94 citations
TL;DR: It is demonstrated that self-rated knowledge and attitudes may influence hospice referral, which supports current efforts to develop medical school curricula and continuing education programs that better cover the many aspects of caring for the dying, including hospice use.
Abstract: Purpose Health care institutions are examining ways to improve physicians' skills in the delivery of end-of-life (EOL) care. Experts have suggested that influencing physicians' knowledge and attitudes concerning EOL care can influence subsequent EOL practices, including hospice use for appropriate patients; yet few studies have examined empirically the influence of physicians' knowledge and attitudes on such practices. The authors assessed the influences of self-rated knowledge and attitudes on physicians' discussions and referrals for hospice care. Method In 1998 and 1999 the authors conducted a cross-sectional study of physicians affiliated with six randomly selected community hospitals in Connecticut with more than 200 licensed medical and surgical beds. Physicians completed a self-administered questionnaire (response rate 52.4%) that assessed self-rated knowledge of terminal care and hospice, a set of attitudinal items, and practices related to hospice discussion and referrals, as well as standard sociodemographic data. Bivariate and multivariate analyses were conducted. Results Self-rated knowledge was significantly associated with referral practices in unadjusted analyses (unadjusted odds ratio [OR]: 0.70; 95% confidence interval [CI]: 0.52, 0.95), although this association was attenuated in adjusted analyses by specialty and other physicians' characteristics (adjusted OR: 0.80; 95% CI: 0.55, 1.18). Attitudes representing support for hospice practices and philosophy were associated with referral practices in adjusted and unadjusted analyses (adjusted OR:0.52; 95% CI: 0.35, 0.77). Conclusions This study demonstrated that self-rated knowledge and attitudes may influence hospice referral. The results support current efforts to develop medical school curricula and continuing education programs that better cover the many aspects of caring for the dying, including hospice use.
94 citations
TL;DR: In stable patients with suspected CAD who are eligible for ICA, the comparable 1-year major adverse cardiovascular events rates following a selective referral and direct referral strategy suggests that both diagnostic approaches are similarly effective.
Abstract: Objectives This study compared the safety and diagnostic yield of a selective referral strategy using coronary computed tomographic angiography (CCTA) compared with a direct referral strategy using invasive coronary angiography (ICA) as the index procedure. Background Among patients presenting with signs and symptoms suggestive of coronary artery disease (CAD), a sizeable proportion who are referred to ICA do not have a significant, obstructive stenosis. Methods In a multinational, randomized clinical trial of patients referred to ICA for nonemergent indications, a selective referral strategy was compared with a direct referral strategy. The primary endpoint was noninferiority with a multiplicative margin of 1.33 of composite major adverse cardiovascular events (blindly adjudicated death, myocardial infarction, unstable angina, stroke, urgent and/or emergent coronary revascularization or cardiac hospitalization) at a median follow-up of 1-year. Results At 22 sites, 823 subjects were randomized to a selective referral and 808 to a direct referral strategy. At 1 year, selective referral met the noninferiority margin of 1.33 (p = 0.026) with a similar event rate between the randomized arms of the trial (4.6% vs. 4.6%; hazard ratio: 0.99; 95% confidence interval: 0.66 to 1.47). Following CCTA, only 23% of the selective referral arm went on to ICA, which was a rate lower than that of the direct referral strategy. Coronary revascularization occurred less often in the selective referral group compared with the direct referral to ICA (13% vs. 18%; p Conclusions In stable patients with suspected CAD who are eligible for ICA, the comparable 1-year major adverse cardiovascular events rates following a selective referral and direct referral strategy suggests that both diagnostic approaches are similarly effective. In the selective referral strategy, the reduced use of ICA was associated with a greater diagnostic yield, which supported the usefulness of CCTA as an efficient and accurate method to guide decisions of ICA performance. (Coronary Computed Tomographic Angiography for Selective Cardiac Catheterization [CONSERVE]; NCT01810198)
94 citations